A right-to-die ethicist faces her hardest choice

Peggy Battin spent most of her academic work exploring a contentious topic that many of us shy away from: decision making at the end of life. Peggy’s field of study took an almost unbearably personal turn when it became time for her husband, Brooke, to decide how to die following a near-debilitating cycling accident.

We reached out to Peggy, asking her to tell us more about what she thinks makes her TEDMED 2014 talk an especially timely one that can help us better understand the current debate over physician aid-in-dying. Here is her response:

Think about the competing tensions over how we die—on the one hand, the desire to be self-determining as much as possible, even at the very end of life, and on the other, the worry that giving people control over their own dying will leave them open to pressures, expectations, and abuse.

I want to be able to die when I want, where I want, with the people I love around me; but I don’t want to be pushed or cajoled or forced into it—not by family members or friends, not by overworked doctors, not by profit-motivated insurers.

Peggy Battin speaks at TEDMED 2014.  Photo: Jerod Harris, TEDMED.

Peggy Battin speaks at TEDMED 2014. Photo: Jerod Harris, TEDMED.

These tensions are fanned by activist groups on both sides. On the one side are the various right-to-die groups, like Compassion and Choices, the Final Exit Network, and many others; physician aid-in-dying, usually called Death With Dignity, has already become legal in four (and a half) U.S. states: Oregon, Washington, Montana, Vermont, and parts of New Mexico. Physician-assisted suicide and active voluntary euthanasia are also legal in the Netherlands, Belgium, Luxembourg, and Switzerland. There are active court cases and/or legislative measures in the United Kingdom, Canada, Australia, France, and much of the developed world.

Why must I be kept alive at such expense when, if I am dying, I would rather die in an earlier, easier, gentler way? That should be my basic right.

On the other side, opposing these measures on the grounds of both moral concern and fears of abuse, are a variety of groups implacably opposed to euthanasia in any form, from the disability-rights group Not Dead Yet to the Catholic Church.

But, you see, if there are such cost savings to be had, don’t you think you might be pressured into it? That’s what “death panels” are all about.

These tensions are further stoked by changes in background epidemiology and concerns over health care costs. The vast majority of people in the developed world now die slow deaths, deaths of heart disease, cancer, various forms of organ failure, the dementias, all of which have characteristically long downhill tail-off slopes, patterns of decreasing function that can also involve pain and suffering, and that also may involve substantial demands on family members and health care. As the populations of the developed countries become increasingly “gray,” this problem intensifies.

Against these tensions, this talk portrays one man’s life and the death that he chooses, a death that is on the border between these two camps: Because it involves the withdrawal of treatment, it legally and morally counts as a “natural” death, but because it involves this man’s own choice of time, place, and the people around him, including medical staff, it looks very much like an assisted death.